Around the world, approximately 18 million women of reproductive age die each year because of non-communicable diseases (NCDs), and two in every three deaths among women are due to an NCD. In fact, NCDs have been the leading cause of death among women globally for at least the past 30 years. And yet, women’s specific needs are often excluded from conversations about NCDs. They are underrepresented in clinical research and the effect of NCDs on women in particular is rarely considered. NCD-related symptoms during pregnancy are commonly misinterpreted or dismissed by clinicians.

Cervical cancer affects 570,000 women a year and kills 311,000. Nine in 10 (88 percent) of the deaths occur in developing countries. This cancer is caused by a common sexually transmitted infection, human papilloma virus (HPV), but is also considered a non-communicable disease (NCD) because of the slower way it presents. Yet, the disease is one of the most preventable and treatable cancers, and cost-effective solutions exist to prevent the disease. Given strong overlaps between HIV and reproductive health, we can and should do more to stop cervical cancer.

One-third of all maternal deaths can be traced to high blood pressure in pregnancy and in the weeks after giving birth. Yet many women don’t know how dangerous high blood pressure can be. And they may not realize they are at risk for many life-threatening conditions such as pre-eclampsia and eclampsia. Because high blood pressure can be asymptomatic, women with hypertension may not feel unwell or even know that their health is compromised.

Multiple sclerosis (MS) is a non-communicable disease that affects maternal health. MS is an unpredictable chronic disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. The progress of this disease, its severity, and specific symptoms cannot yet be predicted and varies by individual. Symptoms may disappear or diminish completely, or they may persist and worsen over time. Typical symptoms include fatigue, numbness and tingling, blurred vision, imbalance, pain, and problems with memory and concentration.

Every day there are more than 800 maternal deaths worldwide. Who are these women? They are reproductive women across the globe. They are our sisters, aunts, friends, and co-workers. They are leaders in our community, family members, and caregivers. When assessing the state of maternal morbidity and mortality in the United States, one must consider not only what we know, but also what must change.

Stacy Ann Walker could have died.

During what she thought was going to be a normal exam, Stacy learned that she would need to have a C-section. While recovering in the hospital, she began to have breathing problems and after some testing was told that her heart had been scarred by an earlier bout of rheumatic fever. Shortly after, she also learned that she had heart failure, an enlarged heart, and problems with multiple heart valves.

She was 29.

The mental health of mothers cannot be studied in isolation, as just a psychological snapshot in time. Their complex lives both past and present must be taken into consideration. When I was researching marriage, motherhood, and social support in Korogocho, an informal settlement in Nairobi, stories I heard underscored how a range of life experiences conspire to affect a woman’s mental health. I heard life histories like this:

When Ann was 17, she met Fredrick, got pregnant and moved in with him when she was 18. Two years later, Fredrick got arrested and was gone for two years. When he came back, she got pregnant with child No. 2 within a month but then left the relationship seven months later because of ongoing conflict. When she was about 23 with a 2-month-old and 5-year-old, Frederick shot her. Two months later, he himself was killed. Four months later, she met the man who would become her second husband. After living together for three years, he took her back to his home to meet his family. She then had her third baby.

“Non-communicable diseases have been the leading cause of death for women for at least the past 30 years but are often underreported and undertreated,” said Priya Kanayson, Policy and Advocacy Manager at NCD Alliance at a recent Wilson Center event on the impact of non-communicable diseases (NCDs) on maternal health. The event marked the official launch of the Maternal Health Initiative’s CODE BLUE series, developed in partnership with EMD Serono, a business of Merck KGaA, Darmstadt, Germany. Globally, in 2018, 73 percent of deaths among women were due to NCDs, amounting to 18 million women of reproductive age dying per year due to NCDs. The compounding effects of NCDs complicate women’s experiences in many unseen ways, and the rise and gravity of NCDs pose a growing and often overlooked challenge to maternal health worldwide.